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Abstract
Background: Tobacco use and exposure to secondhand and thirdhand smoke pose significant public health challenges. The 2005 Smokefree Air Act established baseline protections against tobacco use in Georgia but left a substantial list of exemptions. Several local jurisdictions have enacted additional smokefree ordinances to address these gaps. However, disparities in the scope, coverage, and enforcement of these ordinances create uneven health protections against tobacco-related harm.Objective: This study aimed to develop and apply a legal analysis protocol to systematically evaluate county-level smokefree ordinances in Georgia, assess their strength, and explore associations between ordinance strength and socio-demographic characteristics and smoking prevalence trends.
Methods: A legal epidemiology framework was employed by developing a coding protocol and a quantitative scoring framework to assess ordinances of 30 counties as of December 31, 2023. The counties were purposively selected based on changes in smoking prevalence between 2015 and 2021. Correlation analyses and t-tests were used to explore associations and test hypotheses.
Results: Thirteen of the 30 sampled counties had codified local smokefree regulations. Significant heterogeneity was found in ordinance scope, coverage, and enforcement provisions. Ordinance strength scores varied widely, with Gwinnett County (84/111 points) demonstrating a "Strong" policy, while many counties relied on minimum state standards. Stronger ordinances were generally associated with lower smoking rates, dense population, less rurality, and higher socioeconomic indicators. Counties with the most improved smoking rates between 2015 and 2021 have stronger smokefree ordinances, (p < .001).
Conclusion: This study successfully developed a replicable protocol for analyzing county-level smokefree ordinances. The findings highlight substantial disparities in local smokefree protections.